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Information about Acute lymphoblastic leukaemia

What is it?

This is a summary of information about this condition. For more detailed information we recommend using the NHS Choices website, A link to this can be found in the External Resources tab above.

Acute lymphoblastic leukaemia is a type of cancer that affects the white blood cells. It progresses rapidly and aggressively and requires immediate treatment. Both adults and children can be affected.

Acute lymphoblastic leukaemia is very rare, with around 650 people diagnosed with the condition each year in the UK. Half of all cases diagnosed are in adults and half in children.

Although rare, acute lymphoblastic leukaemia is the most common type of childhood leukaemia. About 85% of the cases that affect children occur in those younger than 15 (mostly between the ages of two and five). It tends to be more common in males than females.

What causes it?

It is a genetic change (mutation) in the stem cells that causes immature white blood cells to be released into the bloodstream.

it's not clear what causes the DNA mutation to occur, but known risk factors include:
  • previous chemotherapy
  • smoking – smokers are much more likely to develop acute leukaemia than non-smoker
  • being very overweight (obese)
  • genetic disorders – a small number of cases of childhood acute lymphoblastic leukaemia are thought to be related to genetic disorders, including Down's syndrome
  • having a weakened immune system – people with lowered immunity (as a result of having HIV or AIDS or taking immunosuppressants) have an increased risk of developing leukaemia

What are the symptoms and signs?

Acute lymphoblastic leukaemia usually starts slowly before rapidly becoming severe as the number of immature white blood cells in the blood increases.

Most of the symptoms are caused by the lack of healthy blood cells in the blood supply. Symptoms include:
  • pale skin
  • feeling tired and breathless
  • repeated infections over a short space of time
  • unusual and frequent bleeding, such as bleeding gums or nosebleeds
  • high temperature (fever) of 38C (100.4F) or above
  • night sweats
  • bone and joint pain
  • easily bruised skin
  • swollen lymph nodes (glands)
  • abdominal pain – caused by a swollen liver or spleen
  • unexplained weight loss
  • a purple skin rash (purpura) 

In some cases, the affected cells can spread from the bloodstream into the central nervous system. This can cause a series of neurological symptoms (related to the brain and nervous system), including:
  • headaches
  • seizures (fits)
  • vomiting
  • blurred vision
  • dizziness

What tests are used to diagnose it?

The first step in diagnosing acute lymphoblastic leukaemia is to check for physical signs of the condition, such as swollen glands, and to take a blood sample.

If the blood sample contains a high number of abnormal white blood cells, it could be a sign of acute leukaemia. A GP will refer to a haematologist (a specialist in treating blood conditions).

Bone marrow biopsy
To confirm a diagnosis of acute leukaemia, the haematologist will take a small sample of bone marrow to examine under a microscope. 

The bone marrow will be checked for cancerous cells and, if found, the type of acute leukaemia will be determined at the same time.

Further tests
A number of additional tests can be used to find out about the progress and extent of the leukaemia. They can also help guide treatment.

Cytogenetic testing 
Cytogenetic testing involves identifying the genetic makeup of the cancerous cells. Specific genetic variations can occur during leukaemia, and knowing what these variations are can have an important impact on treatment.

Immunophenotyping
Immunophenotyping is a test to help identify the exact type of acute lymphoblastic leukaemia. A sample of blood, bone marrow or another type of fluid is studied.

This testing is important as the treatment needed may be slightly different for each type.

Polymerase chain reaction (PCR)
A polymerase chain reaction (PCR) test can be carried out on a blood sample. PCR can help diagnose and monitor the response to treatment.

Lymph node biopsy
If a diagnosis of acute leukaemia is made, further biopsies may be carried out on any enlarged lymph nodes. These will establish how far the leukaemia has spread.

CT scans
If a diagnosis of acute leukaemia is made, a computerised tomography (CT) scan may be used to assess how far the leukaemia has spread and to check that organs such as the heart and lungs are healthy.

Chest X-ray
An X-ray of the chest will show any swollen lymph nodes.

Lumbar puncture
A lumbar puncture may be carried out if there's a risk that acute leukaemia has spread to the nervous system.

What treatments are available?

As acute lymphoblastic leukaemia is an aggressive condition that develops rapidly, treatment usually begins a few days after diagnosis.

Treatment is usually carried out in the following stages
  • induction – initially, treatment aims to kill the leukaemia cells in the bone marrow, restore the balance of cells in the blood and resolve any symptoms
  • consolidation – aims to kill any remaining leukaemia cells in the central nervous system
  • maintenance – involves taking regular doses of chemotherapy tablets to prevent the leukaemia returning
Chemotherapy is the main treatment for acute lymphoblastic leukaemia. Other treatments may include antibiotics and blood transfusions. In some cases, a bone marrow transplant may also be needed to achieve a cure.

Sources

NHS Choices website accessed on 02/07/18
For further information please use link to the NHS Choices website available in External Resources
Contains public sector information licensed under the Open Government Licence v3.0.

The medicines listed below have been approved for use in the UK. Medicines are listed by brand name and the active ingredient shown in brackets. An inverted black triangle (▼) against the name denotes that the medicine is being tracked for adverse events.

If the medicine you are interested in is not shown you can request it to be included by emailing the name of the medicine to medicinerequest@keepmeinformed.eu.

Medicines for this condition


Atriance ▼ (nelarabine)

Besponsa ▼ (inotuzumab ozogamicin)

Blincyto ▼ (blinatumomab)

Glivec ▼ (imatinib)

Iclusig ▼ (ponatinib)

Kymriah ▼ (tisagenlecleucel)

Spectrila ▼ (asparaginase)

Sprycel (dasatinib)

Xaluprine (mercaptopurine)

Jylamvo (methotrexate)

Oncaspar ▼ (pegaspargase)

Evoltra ▼ (clofarabine)

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